Individual
MR. THANE ROCKWELL HALSTEAD III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1201 W NEW YORK ST, AURORA, IL 60506-3667
(630) 301-6629
Mailing address
2503 N WASHTENAW AVE, CHICAGO, IL 60647-1815
(773) 213-2224
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096-0000388
IL
Other
Enumeration date
03/14/2006
Last updated
07/08/2007
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